Hayato Miyachi, Satomi Asai, Yuzuru Takemura
A cost-effectiveness evaluation of reticulocyte measurement in new outpatients with or without hematologic disorders
Background: Although reticulocyte counts provide very useful information, few studies have analyzed the cost-effectiveness of this testing.
Methods: The yield and cost of reticulocyte count testing were analyzed in 719 new outpatients who visited the comprehensive medicine clinics and received both reticulocyte and complete blood count (CBC) testing. A “useful result” (UR) of the testing was defined as a finding that contributed to a change in a physician's diagnosis or decision-making between the pre- and post-test diagnosis. Patients' medical records were thoroughly reviewed for the assignment of URs. A simulation study was performed, blinding the reticulocyte data to the examiners, for the determination of URs generated by CBC alone.
Results: CBC and reticulocyte testing generated a total of 838 URs in 719 patients, while the simulation study demonstrated 612 URs with CBC testing alone. When patients were grouped into 11 major disease categories according to a pre-test diagnosis, clinical effectiveness (UR/patient) varied from 1.69 (hematologic) to 0.13 (metabolic/endocrine patients), with a cost disparity from ¥206 to ¥2784/UR. The cost-effectiveness (?cost/?UR) of reticulocyte addition against CBC alone was ¥515 per additional UR as a whole. Reticulocyte testing showed favorable cost-effectiveness in gastrointestinal (¥234) and hematologic patients (¥338/additional UR), while the test added few URs in metabolic/endocrine and neurologic patients, resulting in possibly unacceptable cost-effectiveness (¥3240 and ¥2916/additional UR, respectively).
Conclusions: Wide disparity in its cost-effectiveness among patients apparently indicated that reticulocyte count testing should be performed for selected patient groups on the basis of its cost-effectiveness.
Clin Chem Lab Med 2006;44:1035–8.
Clinical Chemical Laboratory Medicine, Walter de Gruyter
Print ISSN: 1434-6621
Volume: 44, 08/2006
Pages: 1035 - 1038
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